Presurgical Use of Hypoxic Mixture for Systemic Perfusion Improvement in Neonates With Complex Congenital Heart Disease: A Systematic Review and Meta-Analysis.

Oxygen therapy is essential for the survival of preterm babies and critically ill newborns; however, it has the potential to cause harm through hypoxemia or hyperoxemia. Newborns with complex congenital heart diseases (CHD) suffer from oxygen fluctuations due to the disease and its treatments, altering pre and postnatal development. The objective of this study is to evaluate the evidence for using a hypoxic mixture to decrease pulmonary over-circulation and improve systemic perfusion before surgical interventions in newborns with complex CHD that course with pulmonary over-circulation and systemic hypoperfusion. A search was conducted in PubMed, EMBASE, LILACS, Scielo, Taylor and Francis, SAGE, and Science Direct databases from 2000 to 2022 by two independent authors, including articles with hypoxic mixture treatment in observational studies or trials, with pre-treatment and post-treatment measurements in the same patient, or two groups or more comparisons. Six articles were selected, with a total of 75 patients. The primary outcome was improved systemic circulation and decreased pulmonary over-circulation measured directly with Qp/Qs and indirectly with oxygen saturation and cerebral near-infrared spectroscopy (NIRS). In addition, we performed a meta-analysis for oxygen saturation and cerebral NIRS. Oxygen saturation was the value uniformly reported; three studies reported a significantly lower oxygen saturation after the hypoxic mixture. The cerebral NIRS was measured in 4 studies, with inconsistent results. After using the hypoxic mixture, the Qp/Qs calculation was lower in the two studies but was not statistically significant. The meta-analysis for oxygen saturation showed a fixed effect post-hypoxic therapy of -0.7 (-1.06; -0.35), p < 0.001. The meta-analysis of two studies that measured cerebral NIRS did not show a statistically significant difference at 12 and 24 hours. In conclusion, this is the first systematic review and meta-analysis regarding the pre-operative use of hypoxic gas mixtures for newborns with complex congenital heart disease. Treatment results in lower oxygen saturations, but there is a lack of evidence of improvement in systemic perfusion. The utilization of this therapy is controversial, and better evidence is necessary.

Evaluation of the quality of prenatal care in Colombia during the 2016 Zika outbreak in endemic and non-endemic areas

Objetive: To evaluate the quality of prenatal care during the outbreak of Zika virus infection in endemic and non-endemic vector-borne regions in Colombia. Materials and methods: A descriptive study of prenatal care supplemented by interviews to explore personal experiences during the epidemic. A total of 40 pregnant women in endemic areas and 44 in nonendemic areas participated. Information collected included previous pregnancies, reasons for starting prenatal care, information about Zika, prenatal care (activities of doctors, nurses, laboratories, and images), and perceptions of quality. Then, 8 interviews were conducted with pregnant women diagnosed with Zika. Questioned about knowledge of Zika and the quality of medical care services. Results: Problems with laboratories and diagnostic images were found in both regions and dehumanizing treatment in the endemic region. Women from the endemic region received news and communications about the effects of Zika during pregnancy, causing anxiety and fear among some women. The quality of health care was not what the women expected and they thought they would receive more care from doctors and nurses. Discussion: Our findings show deficiencies in education provided in health institutions. The experience during prenatal control in the endemic regions was imprecise and the information came from other sources, different from the health sector. Adittionally, support and follow-up was deficient as well. It's possible that health professionals have few knowledge about information management, which generated confusion, fear and uncertainty among the pregnant women about the adverse effects on the newborns. Conclusions: Findings suggest deficiencies in the technical quality of the prenatal care provided, particularly in the region that was endemic for vector-borne diseases. Reproductive health services and the technical quality of prenatal care need to be strengthened, especially during a sanitary crisis.

Objetivo: Evaluar la calidad de la atención prenatal durante la epidemia de Zika en regiones endémicas y no endémicas de infecciones trasmitidas por vectores en Colombia. Materiales y Métodos: Estudio descriptivo de la atención prenatal complementado con entrevistas, con el fin de explorar experiencias personales durante la epidemia. Participaron 40 gestantes en zona endémica y 44 en no endémicas. La información recolectada incluyó embarazos previos, razones para iniciar control prenatal, información sobre Zika, control prenatal (actividades de médicos, enfermeras, laboratorios e imágenes) y percepción de calidad. Luego se realizaron 8 entrevistas a gestantes con diagnóstico de Zika. Se interrogó sobre conocimiento del Zika y calidad de los servicios de atención médica. Resultados: Se encontraron problemas con laboratorios e imágenes diagnósticas en ambas regiones y trato deshumanizado en la región endémica. Las gestantes en la región endémica recibieron noticias y comunicados sobre los efectos de Zika durante el embarazo, lo que causó ansiedad y miedo en algunas mujeres. La calidad de la atención medica no era la deseada y pensaron que recibirían mejor atención de médicos y enfermeras. Discusión: Nuestros hallazgos demuestran educación deficiente en las instituciones de salud. La experiencia durante el control prenatal en las regiones endémicas fue imprecisa y venía de fuentes diferentes al sector salud. Además, el soporte y seguimiento fue deficiente. Es probable que el personal de salud tenga poco conocimiento sobre cómo manejar la información, lo cual generó confusión, miedo e incertidumbre entre las gestantes sobre los efectos adversos en los bebes. Conclusiones: Los hallazgos sugieren deficiencia en la calidad técnica de la atención prenatal, particularmente en la región endémica. Es necesario fortalecer los servicios de salud reproductiva y la calidad técnica de la atención prenatal, especialmente durante crisis sanitaria.

Maternal-Fetal Results of COVID-19-Infected Pregnant Women Treated with Extracorporeal Membrane Oxygenation: A Descriptive Report.

OBJECTIVE: COVID-19 infection may produce severe pneumonia, mainly in the adult population. Pregnant women with severe pneumonia are at high risk of developing complications, and conventional therapy sometimes fails to reverse hypoxemia. Therefore, extracorporeal membrane oxygenation (ECMO) is an option in cases with refractory hypoxemic respiratory failure. This study aims to evaluate the maternal-fetal risk factors, clinical characteristics, complications, and outcomes of 11 pregnant or peripartum patients with COVID-19 treated with ECMO. STUDY DESIGN: This is a retrospective descriptive study of 11 pregnant women undergoing ECMO therapy during the COVID-19 pandemic. RESULTS: In our cohort, four patients underwent ECMO during pregnancy (36.3%) and 7 during the postpartum period. Initially, they started on venovenous ECMO, and three patients were required to change modality due to clinical conditions. In total, 4/11 pregnant women (36.3%) died. We established two periods that differed in the implementation of a standardized care model for reducing associated morbidities and mortality. Neurological complications were responsible for most deaths. Regarding fetal outcomes at early-stage pregnancies on ECMO (4), we report three stillbirths (75%), and one newborn (twin pregnancy) survived and had a favorable evolution. CONCLUSION: At later-stage pregnancies, all newborns survived, and we did not identify any vertical infection. ECMO therapy is an alternative for pregnant women with severe hypoxemic respiratory failure due to COVID-19, and may improve maternal and neonatal results. Regarding fetal outcomes, the gestational age played a definitive role. However, the main complications reported in our series and others are neurological. It is essential to develop novel, future interventions to prevent these complications.

Estudio ecológico de la sífilis gestacional y congénita en Colombia, 2012-2018 / Ecological study of gestational and congenital syphilis in Colombia, 2012-2018

Objetivos: Describir el comportamiento de la sífilis gestacional y congénita en Colombia, entre el 2012 y 2018, a partir de registro de notificación Nacional. Materiales y Métodos: Estudio ecológico, exploratorio a partir de Notificaciones al sistema de vigilancia de salud Pública. Se estimaron la tasa de incidencia y la razón de prevalencia para cada departamento. Se establecieron cada una las estimaciones según rangos, para los 33 departamentos evaluados y se expresaron en mapas a escala de grises según tasas y razones evaluadas. Además, se presentan curvas epidemiológicas por semanas notificación para sífilis gestacional y congénita. Resultados. Arauca, Santander, Cesar y Caldas, presentaron el mayor incremento entre 2012 y 2018 para sífilis gestacional. Para el mismo periodo, Santander, Casanare y Amazonas presentaron un aumento para sífilis Congénita, mientras que en los demás departamentos se evidenció una disminución en los eventos. Se encontraron diferencias significativas en el reporte de casos entre un año y otro, para el país, en ambos eventos (p< 0,001). Conclusiones. En Colombia se encontró un aumento de sífilis gestacional, mientras, para sífilis congénita existió variabilidad con tendencia a aumentar en los últimos años.

Objective: To describe the behavior of pregnancy and congenital syphilis in Colombia between 2012 and 2019 according to national notifications records. Materials and Methods: An ecological exploratory study was conducted based on notifications to the public health surveillance system. The incidence rate and prevalence ratio were estimated for each department. Each estimate was established per ranges for 33 departments evaluated and expressed in grayscale maps based on rates and ratios evaluated. Epidemic curves by week of notification for pregnancy and congenital syphilis are also shown. Results: Arauca, Santander, Cesar and Caldas had the highest increase in pregnancy syphilis between 2012 and 2019 while Santander, Casanare and Amazonas had an increase in congenital syphilis during the same period. Other departments had a decrease in these events. Significant differences were found in case reporting from year to year in both events in the country (p<0.001). Conclusions: In Colombia, an increase in pregnancy syphilis was found while a variability with an increasing trend was found for congenital syphilis in recent years.

Objetivos: Descrever o comportamento da sífilis gestacional e congênita na Colômbia entre 2012 e 2019, com base nos registros nacionais de notificação.Materiais e Métodos: Estudo ecológico, exploratório, baseado em notificações ao sistema de vigilância sanitária pública. A taxa de incidência e a taxa de prevalência foram estimadas para cada departamento. As estimativas foram estabelecidas de acordo com intervalos para os 33 departamentos avaliados e expressas em mapas em escala de cinza, de acordo com as taxas e rácios avaliados. Além disso, curvas epidemiológicas por semanas de notificação são apresentadas para sífilis gestacional e congênita. Resultados: Arauca, Santander, Cesar e Caldas apresentaram o maior aumento entre 2012 e 2019 para a sífilis gestacional. No mesmo período, Santander, Casanare e Amazonas mostraram um aumento para a sífilis congênita, enquanto os outros departamentos mostraram uma diminuição nos eventos. Foram encontradas diferenças significativas no relato de casos de um ano para o outro, para o país, em ambos os eventos (p<0,001). Conclusões. Na Colômbia, houve um aumento da sífilis gestacional, enquanto para a sífilis congênita houve variabilidade com tendência a aumentar nos últimos anos.

Evaluación de la antropometría en neonatos sanos. No todas las medidas son relevantes / Anthropometry assesment in healthy neonates. Not all measurements are relevant

Resumen Las medidas antropométricas se han usado para evaluar el crecimiento fetal y neonatal, además de determinar factores de riesgo de forma temprana. Clásicamente se han tomado el peso, talla, perímetro cefálico, torácico y abdominal. Son usadas para establecer condiciones como peso bajo o elevado para la edad gestacional, y con base en esto poder definir riesgos tempranos y tardíos. Otra medida sumamente importante es el perímetro cefálico, misma que determina neonatos con potencial riesgo neurológico. Estas tres medidas son clave como parte de la evaluación inicial neonatal, además de que se incluyen en el seguimiento del crecimiento y desarrollo infantil. No obstante, otras mediciones rutinarias como el perímetro torácico y abdominal, en neonatos con adaptación espontánea y exploración física normal (neonatos sanos), puede que aporten poco acerca del estado de salud neonatal. Estas últimas medidas no forman parte de los parámetros de seguimiento del crecimiento infantil, ni cuentan con gráficas de percentiles extrapolables para género y edad gestacional. Todas estas medidas están condicionadas por múltiples factores como genética, raza y nutrición, entre otros. Es momento de analizar las medidas rutinarias al momento del nacimiento de neonatos sanos, y priorizar las extrapolables a implicaciones clínicas relevantes.

Abstract Anthropometric measurements are used to assess fetal and neonatal growth and determine early risk factors. Classically, weight, height, head circumference, thoracic and abdominal circumference are the usual measures. They are used to identify conditions such as low or high weight for gestational age and, based on this, to determine early and late risks. Another important measurement is head circumference, which determines neonates with potential neurological risk. These three measures are key as part of the initial neonatal evaluation, and they are also a part of the child's growth monitoring and development. However, other routine measurements such as chest and abdominal circumferences, in newborns with spontaneous adaptation and normal physical examination (healthy neonates) may provide little information about the neonatal health status. These last measurements are not part of the child growth monitoring parameters, nor do they have percentile graphs that can be extrapolated to gender and gestational age. All these measures are conditioned by multiple factors such as genetics, race, and nutrition, among others. It is time to analyze routine measures at the time of birth of healthy newborns and prioritize those that can be extrapolated to relevant clinical implications.

[Congenital toxoplasmosis: the importance of adherence to guidelines and clinical implications in Colombia.] / Toxoplasmosis congénita: la importancia de la adherencia a las guías y las implicaciones clínicas en Colombia.

INTRODUCCIÓN: La toxoplasmosis congénita continúa siendo un problema de salud pública. Aun cuando existen guías plenamente divulgadas y conocidas, se observa poca implementación de ellas en algunas instituciones de salud y una inadecuada interpretación de las pruebas serológicas en las gestantes. Esto puede generar falta de captación y tratamiento en embarazadas con primoinfección por Toxoplasma gondii. CASOS CLÍNICOS: Se reportan dos casos de toxoplasmosis congénita, uno de ellos con desenlace fatal. En ambos no se siguieron las guías de práctica clínica, lo cual conllevó un diagnóstico tardío y, en consecuencia, un manejo en condiciones inapropiadas con daños graves. CONCLUSIONES: La toxoplasmosis es una infección congénita aún prevalente en algunos países, con secuelas graves, discapacidad neurológica y riesgo de daño ocular, incluso tardío. Además, existen algunas variedades de cepas de T. gondii con un comportamiento más agresivo en Latinoamérica, lo cual empeora la presentación de los casos e incluye mayor riesgo de muerte. BACKGROUND: Congenital toxoplasmosis continues to be a public health problem. Although clinical guidelines have been divulgated and are well known, they are not implemented in some health institutions, in addition of an inappropriate interpretation of the serological tests in pregnant women. This situation can lead to lack of screening and treatment in pregnant women with primary Toxoplasma gondii infection. CASE REPORTS: We report two cases of congenital toxoplasmosis, one with a fatal outcome. In both cases, the clinical guidelines were not initially followed, leading to a delayed diagnosis and, consequently, an inappropriate management in conditions with severe damage. CONCLUSIONS: Toxoplasmosis is a congenital infection still prevalent in some countries, with severe sequelae, neurological disability, and even late risk of ocular damage. ­Additionally, some varieties of the T. gondii strains have a more aggressive pattern in Latin America, worsening the clinical presentation of cases and including a high risk of death.

Toxoplasmosis congénita: la importancia de la adherencia a las guías y las implicaciones clínicas en Colombia / Congenital toxoplasmosis: the importance of adherence to guidelines and clinical implications in Colombia

Resumen Introducción: La toxoplasmosis congénita continúa siendo un problema de salud pública. Aun cuando existen guías plenamente divulgadas y conocidas, se observa poca implementación de ellas en algunas instituciones de salud y una inadecuada interpretación de las pruebas serológicas en las gestantes. Esto puede generar falta de captación y tratamiento en embarazadas con primoinfección por Toxoplasma gondii. Casos clínicos: Se reportan dos casos de toxoplasmosis congénita, uno de ellos con desenlace fatal. En ambos no se siguieron las guías de práctica clínica, lo cual conllevó un diagnóstico tardío y, en consecuencia, un manejo en condiciones inapropiadas con daños graves. Conclusiones: La toxoplasmosis es una infección congénita aún prevalente en algunos países, con secuelas graves, discapacidad neurológica y riesgo de daño ocular, incluso tardío. Además, existen algunas variedades de cepas de T. gondii con un comportamiento más agresivo en Latinoamérica, lo cual empeora la presentación de los casos e incluye mayor riesgo de muerte.

Abstract Background: Congenital toxoplasmosis continues to be a public health problem. Although clinical guidelines have been divulgated and are well known, they are not implemented in some health institutions, in addition of an inappropriate interpretation of the serological tests in pregnant women. This situation can lead to lack of screening and treatment in pregnant women with primary Toxoplasma gondii infection. Case reports: We report two cases of congenital toxoplasmosis, one with a fatal outcome. In both cases, the clinical guidelines were not initially followed, leading to a delayed diagnosis and, consequently, an inappropriate management in conditions with severe damage. Conclusions: Toxoplasmosis is a congenital infection still prevalent in some countries, with severe sequelae, neurological disability, and even late risk of ocular damage. Additionally, some varieties of the T. gondii strains have a more aggressive pattern in Latin America, worsening the clinical presentation of cases and including a high risk of death.

Community-Acquired Neonatal SARS-CoV-2 Infection Associated with Neurological Symptoms in Colombia.

INTRODUCTION: The SARS-CoV-2/COVID-19 may produce neurological manifestations, including its occurrence in children, and newborns, which has been little reported so far in newborns with COVID-19. CASE: We present a case in Colombia, of community-acquired neonatal infection of SARS-CoV-2, with suggestive symptoms, such as fever, and showing neurological findings, such as drowsiness, poor suction and mild hypotonia for a short time. DISCUSSION: The clinical manifestations of SARS-COV-2 in neonates are beginning to be described in detail. We report a case of SARS-COV-2-associated neurological compromise in a newborn, with features of drowsiness, poor suction and hypotonia.

Perception of COVID-19 Vaccination Amongst Physicians in Colombia.

Introduction: The SARS-CoV-2/COVID-19 pandemic has triggered the need to develop rapidly effective and safe vaccines to prevent infection, particularly in those at-risk populations such as medical personnel. This study's objective was to assess the perception of COVID-19 vaccination amongst Colombian physicians featuring two different scenarios of COVID-19 vaccination. Methods: A cross-sectional analytical study was carried out through an online survey directed at medical staff in several cities in Colombia. The percentage of physicians who have a positive perception to be vaccinated and the associated factors that determine that decision were determined. A binomial regression analysis adjusted for age and sex was carried out, taking as a dependent variable the acceptance of free vaccination with an effectiveness of 60 and 80%. The most significant factors were determined in the non-acceptance of vaccination. Results: Between 77.0% and 90.7% of physicians in Colombia accept COVID-19 vaccination, according to the scenario evaluated where the vaccine's effectiveness was 60 or 80%, respectively. Medical specialty, having never paid for a vaccine, recommending the administration of the vaccine to their parents or people over 70 years, and dispensing the vaccine to their children, were the factors to consider to be vaccinated for free with an effectiveness of 60% and 80%. Conclusions: There is a high perception of the intention to vaccinate physicians in Colombia against COVID-19, and this is very similar to that of the general population.

Prematuro con perforación intestinal espontánea de presentación muy precoz / Preterm neonate with spontaneous intestinal perforation of very early presentation

Resumen Introducción: La perforación intestinal espontánea es una condición que afecta principalmente a neonatos pretérmino. Caso clínico: Se presenta el caso de un neonato pretérmino de 26 semanas de gestación con neumoperitoneo en las primeras 24 horas de vida. Por lo precoz del cuadro y los hallazgos radiológicos, la primera hipótesis diagnóstica fue una perforación gástrica. Sin embargo, en la laparotomía se encontró una perforación ileal única, sin hallazgos de enterocolitis. Conclusiones: La perforación intestinal espontánea se ha asociado con intervenciones médicas, como el uso concomitante de esteroides e indometacina. Otras intervenciones, como el uso de magnesio prenatal y la colocación de surfactante pulmonar de forma mínimamente invasiva, se han propuesto como factores de riesgo para su desarrollo. En la actualidad, deben evaluarse la perforación intestinal espontánea y sus asociaciones. Las presentes y futuras investigaciones podrían contribuir a aclarar el papel de las intervenciones mencionadas en la revisión preliminar de la literatura.

Abstract Background: Spontaneous intestinal perforation is a condition that mainly affects preterm infants. Case report: The case of a preterm infant of 26 weeks of gestation with pneumoperitoneum in the first 24 hours of life is described. Due to the early symptoms and radiological findings, the first diagnostic hypothesis was gastric perforation. However, at laparotomy, a unique ileal perforation was found, without findings of enterocolitis. Conclusions: Spontaneous intestinal perforation is a complication associated with medical interventions such as the concomitant use of steroids and indomethacin. Recently, other interventions, such as the use of prenatal magnesium and treatment with exogenous pulmonary surfactants in a minimally invasive way have been proposed as risk factors for its development. At present, clinicians should evaluate spontaneous intestinal perforation and its associations, and ongoing and future research may clarify the role of the interventions mentioned in the review of preliminary literature.

[Preterm neonate with spontaneous intestinal perforation of very early presentation]. / Prematuro con perforación intestinal espontánea de presentación muy precoz.

Introducción: La perforación intestinal espontánea es una condición que afecta principalmente a neonatos pretérmino. Caso clínico: Se presenta el caso de un neonato pretérmino de 26 semanas de gestación con neumoperitoneo en las primeras 24 horas de vida. Por lo precoz del cuadro y los hallazgos radiológicos, la primera hipótesis diagnóstica fue una perforación gástrica. Sin embargo, en la laparotomía se encontró una perforación ileal única, sin hallazgos de enterocolitis. Conclusiones: La perforación intestinal espontánea se ha asociado con intervenciones médicas, como el uso concomitante de esteroides e indometacina. Otras intervenciones, como el uso de magnesio prenatal y la colocación de surfactante pulmonar de forma mínimamente invasiva, se han propuesto como factores de riesgo para su desarrollo. En la actualidad, deben evaluarse la perforación intestinal espontánea y sus asociaciones. Las presentes y futuras investigaciones podrían contribuir a aclarar el papel de las intervenciones mencionadas en la revisión preliminar de la literatura.

Factores asociados a la decisión paterna sobre el retorno a clases presenciales en Colombia durante la pandemia COVID-19 / Associated factors with the paternal decision on the return to face-to-face classes in Colombia during the COVID-19 pandemic

Resumen Introducción: La pandemia por SARS-CoV-2 generó el cierre de los colegios y el inicio de la educación virtual, como medida para disminuir la propagación del virus. Rápidamente, se planteó el regreso a los colegios; sin embargo, es probable que exista un rechazo de los padres por el regreso a clases de forma presencial o mediante alternancia. Por esta razón, se evaluaron los factores asociados a esta oposición. Material y métodos: Se realizó un estudio analítico de corte transversal mediante una encuesta, dirigida a padres que acuden a consultorios con sus hijos en varias ciudades de Colombia. Se determinó el porcentaje de padres que deseaban mantener la escolarización mediante la virtualidad y los factores asociados que motivan a no aceptar el pronto retorno a clases presenciales. Se realizó un análisis de regresión binomial para estimar razones de prevalencia (RP), ajustado a la edad de los padres, tomando como variable dependiente la aceptación de la virtualidad como estrategia para no regresar a los colegios, y se determinaron los factores de mayor importancia en la no aceptación del retorno a clases. Resultados: El 81,06 % de los padres no acepta el retorno a clase de forma presencial. El principal factor asociados a esta decisión fue que alguno de los padres presentara alguna comorbilidad, principalmente, hipertensión y obesidad. Tener hijos mayores de 10 años (RP: 2,64: IC 95 %: 1,48-4,72), convivir con personas mayores de 70 años (RP: 2,2; IC 95 %; 1,46-3,29) y conocer alguna persona fallecida por COVID-19 (RP: 1,86; IC 95 %: 1,42-2,44) también fueron asociadas a no aceptar el retorno a clase presencial. Conclusiones: Existe una clara tendencia a mantener la virtualidad como opción educativa en Colombia para el no regreso a clases presenciales en población de estrato medio y alto. Los factores asociados sugieren una forma de protección familiar. Esta evidencia debe considerarse específica para el periodo de recolección de datos y el grupo incluido en el estudio. Se requieren estudios en los estratos socioeconómicos más bajos, donde se supone ocurren más efectos adversos asociados al no retorno a clases presenciales.

Abstract Introduction: The SARS-CoV-2 pandemic led to the closure of schools and the beginning of virtual education, as a measure to reduce the spread of the virus. Shortly after, there was a planned return to in-person learning, however, there existed the possibility of parents rejecting the notion of returning to in-person learning or a hybrid model of in-person and online learning, there is likely a rejection of parents to return to classes in person. For this reason, the factors possibly associated with this opposition were evaluated. Material and methods: A cross-sectional analytical study was carried out through an online survey aimed at parents who attend private clinics with their children, in several cities of Colombia. The percentage of parents who wished to maintain their children's schooling through virtuality and the factors associated with not accepting the prompt return to face-to-face classes were determined. A binomial regression analysis, to estimate Prevalence Ratios (PR), adjusted for the age of the parents was carried out, taking as a dependent variable the acceptance of virtuality as a strategy for not returning to school and the most important factors in the non-acceptance of returning to school were determined. Results: 81.06% of the parents did not accept the return to class in person. The main factors associated with this decision were that one of the parents had some comorbidity, mainly hypertension and obesity. Having children older than 10 years (PR: 2.64; 95% CI: 1.48-4.72), living with people older than 70 years (PR: 2.2; 95% CI;1.46-3.29), and knowing someone who died from COVID-19 (PR: 1.86; 95% CI 1.42- 2.44) were associated with not accepting the return to face classes. Conclusions: There is a clear tendency to maintain virtuality as an educational option in Colombia for not returning to face-to-face classes in the middle and upper stratum population. Associated factors suggest a form of family protection. This evidence should be considered specific for the data collection period and the group included in the study. Studies are required in the lowest socioeconomic strata, where it is assumed that there are more adverse effects associated with not returning to face-to-face classes.

Infecciones por Staphylococcus aureus resistente a Meticilina en niños adquirida en la comunidad. Reporte de casos / Staphylococcus aureus infections resistant to Methicillin acquired by children in the community. Case reports

Resumen Staphylococcus aureus meticilino resistente es un microorganismo aislado, principalmente a nivel hospitalario; sin embargo, esta condición ha cambiado en los últimos años, pues hoy en día se reconoce como el agente causal de infecciones adquiridas en la comunidad por niños sin factores predisponentes asociados. Esto puede variar en todo el mundo, pero hay una alerta global por el aumento del problema. En América Latina, esto ya ha sido reportado en países como Argentina y Colombia. Evaluar los gérmenes circulantes a nivel regional y sus características genotípicas es importante para el manejo clínico de algunos pacientes, incluso niños menores de un año, quienes también son susceptibles a este tipo de infección. En este reporte, se presentan dos casos en niños menores de un año, incluyendo un recién nacido, lo que hace de este un grupo etario susceptible. La sospecha clínica de esta bacteria de adquisición en la comunidad ayuda a la elección adecuada del esquema antibiótico, con mejores resultados clínicos. Por lo tanto, debe ser una prioridad realizar la vigilancia local de las infecciones por Staphylococcus aureus adquiridas en la comunidad y determinar los protocolos de manejo, según los grupos de edad y condiciones asociadas.

Abstract Methicillin-resistant Staphylococcus aureus is an isolated germ mainly in hospital settings. However, this condition has changed in the last years. Today, it is recognized as a germ that causes infections acquired in the community by children, without predisposing risk factors. This may vary around the world, but there is a global alert for the increase of the problem. In Latin America, this has already been reported in some countries such as Argentina and Colombia. Evaluating the circulating germs at regional level and their genotypic characteristics is important for the clinical management of some patients, including children under a year of age as they are also susceptible to this infection. We are presenting two cases in children under one year of age, including a neonate, which are a susceptible age group. Clinical suspicion of this community acquired bacterium helps to choose the appropriate antibiotic regimen, with better clinical results. Therefore, it must be a priority to carry out the local surveillance of Staphylococcus aureus infections acquired in the community and determine the management protocols, according to age groups and associated conditions.

A Cluster of Neonatal Infections Caused by Candida auris at a Large Referral Center in Colombia.

BACKGROUND: Globally, Candida auris is an emerging pathogen that poses an essential threat in healthcare settings presenting as outbreaks requiring significant allocation of infection control interventions to curb transmission. This fungal pathogen was initially identified in 2009 in Japan, but it has spread to all continents. Candida auris poses significant diagnostic and treatment challenges. Conventional microbiology laboratories often misidentify this pathogen as Candida haemulonii or as other Candida spp., Rhodoturola glutinis, and even with some bacterial pathogens, including Neisseria meningitidis serogroup A. Furthermore, C. auris displays distinct mechanisms of antifungal resistance to azoles and amphotericin B formulations. Most of the case series and outbreak reports have included invasive infections in adult populations. METHODS: Herein, we present a cluster of neonatal infections caused by Candida auris at a large referral center in Colombia. RESULTS: We report a case series of 8 neonates and infant patients who were seen at a large referral center in Colombia and who develop invasive infections caused by C. haemulonii and C. auris. DISCUSSION: Our report highlights the diagnostic challenges in identifying this fungal pathogen correctly, its clinical spectrum of disease, recommendations for empiric antifungal therapy, and it is not always associated with a high case fatality rate.

Everolimus for severe arrhythmias in tuberous sclerosis complex related cardiac rhabdomyomas.

Intracardiac rhabdomyoma is the most common primary cardiac tumor in children. Most cases are associated with tuberous sclerosis complex (TSC). Most of them are asymptomatic in the neonate and do not require treatment. However, some develop cardiovascular symptoms such as arrhythmias, heart failure, and ventricular inflow/outflow tract obstruction in the neonatal period with early death. Many of these tumors are not candidates for surgical resection and medical management is limited. Treatment with mammalian target of rapamycin (mTOR) inhibitor is currently approved for the management of central nervous tumors and angiomyolipoma in TSC. Two patients with malignant arrhythmias related to nonsurgical multiple rhabdomyomas associated with TSC who were successfully treated with an mTOR inhibitor were described. Everolimus therapy showed significant regression of rhabdomyomas with rapid improvement of arrhythmias and heart failure prior to tumor shrinkage.

SARS-CoV2 como causa de sepsis neonatal tardía, reporte de un caso / SARS-CoV2 as a cause of late neonatal sepsis, a case report

Resumen Introducción: La infección por SARS Cov2 en los niños tiene un comportamiento clínico menos severo que en adultos y por lo tanto menor mortalidad. Esta infección puede afectar neonatos y estos pueden adquirir la infección por trasmisión horizontal, con manifestaciones clínicas variables. Si bien, el neonato hijo de madre positiva para SARS CoV 2 ha sido el de mayor foco de atención, otros neonatos pueden adquirir la infección por casos positivos domiciliarios, sintomáticos o no. Reporte del caso: Recién nacido previamente sano, de 22 días con manifestaciones sistémicas como fiebre, síntomas respiratorios leves y deposiciones liquidas frecuentes, sin moco ni sangre. Sin antecedentes de infecciones en la familia. El tratamiento fue sintomático, con acetaminofén, líquidos endovenosos y con evolución adecuada. Los laboratorios fueron inespecíficos, y se realizó estudio para SARS Cov2 por la pandemia actual. El reporte fue positivo y la familia rechazó realizarse pruebas. Discusión: La infección neonatal por SARS-CoV2 ha sido relacionada con síntomas como fiebre, cuadros respiratorios y gastrointestinales leves, generalmente con noción de contagio de personas sintomáticas o asintomáticas, que pueden ser subestimados. Es posible que el diagnóstico neonatal, sea la señal de adultos asintomáticos. Actualmente, ante los reportes literarios y la pandemia actual, se deberían realizar pruebas a neonatos febriles y con otros síntomas sistémicos. Además de realizar seguimiento a los neonatos afectados.

Abstract Introduction: SARS Cov2 infection in children has a clinical evolution not as severe as in adults and therefore lower mortality. This infection can affect neonates and they can acquire the infection by horizontal transmission, with variable clinical manifestations. Although the neonate born to a mother positive for SARS-CoV 2 has been the one with the greatest focus of attention, other neonates can acquire the infection from positive cases at home, symptomatic or not. Case report: A 22-day-old, previously healthy newborn with systemic manifestations such as fever, mild respiratory symptoms and frequent liquid stools, without mucus or blood. No history of infections in the family. The treatment was symptomatic, with acetaminophen, intravenous fluids and with good evolution. Laboratories were nonspecific, and the study for SARS Cov2 was realized due to the current pandemic. The report was positive and the family refused to carry out tests. Discussion: Neonatal SARS CoV2 infection has been associated with symptoms such as fever, mild respiratory and gastrointestinal symptoms, usually with a positive notion of contagion from symptomatic or asymptomatic people, that can be underestimated.. It is possible that the diagnosis in a neonate could be the alarm on asymptomatic adults. Currently, due to the reported cases and the SARS CoV2 pandemic, newborns with fever and other systemic symptoms should be tested in the neonatal period. On the other hand, perform a follow-up of affected newborns.